Friday, 28 June 2013

Will road deaths be a development priority?

Writing today for Guardian Global Development, Oxfam policy adviser and development blogger Duncan Green asks why road traffic injuries are still being ignored by the development community. Duncan writes:

Duncan Green: "road safety will
become ever more prominent"

"Road traffic kills as many people as malaria, but getting Nairobi's bus drivers to slow down is much easier than tackling malaria. So if we know what to do, and the remedies are cheap, why isn't road safety much higher up the development agenda?"..."My theory is that the collective development gaze skips over road deaths and others like tobacco or alcohol because they are too familiar. The world of aid and development prefers the exotic, the "other". But if you think roads, booze and fags are tricky issues for the aid industry to tackle, try obesity – increasingly present among poor communities in poor countries, as a recent visit to South Africa brought home to me, often side by side with malnutrition. Can you imagine an aid organisation launching a fundraising appeal to tackle obesity?"
Of course a programme to tackle obesity would need to include road safety - the perception (and often in a low and middle income country context the reality) of a lack of safety on the streets being a major motivation for those people who can to give up walking and cycling, or to prevent their children from walking to school, and take to their cars, leaving the danger to the poor. This inter-connection of road safety with other health and environmental agendas holds out the best hope for mainstreaming road injury prevention into development policies and programmes. But, as Duncan Green argues, we first need to surmount the indifference of development policy leaders in the West. He may be correct that they seek the exotic, the quintessentially tropical diseases. They have perhaps become inured to road traffic injuries, lulled by the steady march of improvement and reduced casualties in the UK, Australia, Sweden or the US and the way the media in these countries overwhelmingly portrays road safety as something boring and unsexy, even amusing, preserve of the finger-wagging tendency. Despite considering themselves to be in touch with what is happening in the 'developing' world, and despite being endowed with sophisticated analysis of myriad social issues, these experts seem to ignore the evidence of dysfunction and inequality on the very roads they travel through to visit their health, governance or economic development projects. What, after all, is the real difference between the collapse of a poorly built Bangladeshi garment factory and the cumulative effect of a daily death toll exacted by a poorly designed Bangladeshi road?

Yet coincidentally, this week also saw the publication of a report by the Overseas Development Institute, the UK's leading development think tank, which argues that if the post-2015 goals are to deliver universal access to infrastructure, road safety must be addressed:

“Investment
in transport infrastructure and services is likely to have a significant impact
on poverty and more generally on economic growth, productivity and employment.
Transport's importance goes beyond a question of mobility, by providing connectivity
and social benefits. By one estimate, 900 million people have inadequate access
to road transport (Roberts et al., 2006), but data on access to transport are
limited. The poorest are often neglected by service providers, and in urban
areas access is affected by affordability. With road traffic causing 1.3 million
deaths a year, the majority in developing countries, road safety is a major
concern for future transport sector development. The transport sector is a
major source of greenhouse gas emissions and particulate air pollution,
especially in urban areas...A sustainable transport goal would contribute to reduction of global greenhouse gases and particulate air pollution. This would help mitigate climate change and have a significant positive impact on health. Road safety measures would also improve overall health status."

Could this be part of a shift in awareness and attitudes towards road traffic injury within the development community? Kevin Watkins, now Director of the ODI, has been an early adopter of road safety amongst development experts, arguing the case for integrating road traffic injury prevention into wider development objectives. The Global Burden of Disease 2010 study, published last year by the Institute for Health Metrics and Evaluation and the Lancet again confirmed that road traffic injury is a leading contributor to death, disability and injury amongst young people in every part of the world. There have been flashes of recognition from UNICEF, which addressed the impact of road traffic injury in two of its recent State of the World's Children reports, and UNICEF's executive director Anthony Lake recently described the impact road crashes have on the young, but these perceptive diagnoses of the problem are yet to be followed up with any organised policy advocacy or programme implementation. There are strong advocates for action on road safety in the World Bank and some of the other development banks, but in none of these organisations has there yet emerged someone in a senior leadership role who is prepared to make road safety a major priority.

So the post-2015 'Sustainable Development Goals' debate provides a real opportunity for road safety advocates to make the case for integration with wider public health, sustainable transport and environmental issues, to build a broad coalition supporting road injury prevention as a way to tackle a problem which is itself a major global killer, but also a symptom of wider inequality and poverty, and a contributor to the growing crisis of non-communicable diseases. And it is an opportunity to challenge those who, through fatalism or ignorance, see road traffic injury as simply a national transport problem, an unpleasant side-effect of mobility, rather than an international epidemic which we all have a stake in preventing.